Test ID: 80027
B-Cell Lymphoma, FISH, Tissue

Detecting a neoplastic clone associated with the common chromosome abnormalities seen in patients with various B-cell lymphomas

Tracking known chromosome abnormalities and response to therapy in patients with B-cell neoplasms

The number of probes ordered will determine the price of the testing. When this test is ordered, a charge for 2 FISH probes and interpretation is included. If additional probes or the entire panel are ordered, additional probes charges will be added.

If the patient is being tracked for known anomalies, indicate which anomalies need to be investigated.

Depending on the lymphoma subtype suspected, the most appropriate probes to order are listed in the table: Common Chromosome Anomalies in B-Cell Lymphomas in Clinical Information.

• Cytogenetics Hematologic FISH Panel Patient Information Sheet

Fluorescence In Situ Hybridization (FISH) with DNA Probes

Provide a reason for referral with each specimen. The laboratory will not reject testing if this information is not provided, but appropriate testing and interpretation may be compromised or delayed.

Forms:

1. Cytogenetics Hematologic FISH Panel Patient Information Sheet (Supply T603) in Special Instructions

2. If not ordering electronically, submit a Cytogenetics Hematologic Disorders Request Form (Supply T607) with the specimen.

Advise Express Mail or equivalent if not on courier service.

Submit only 1 of the following specimens:

Specimen Type: Lymph node

Preferred: Tissue block

Collection Instructions: Formalin-fixed, paraffin-embedded (FFPE) tumor tissue block. Include 1 hematoxylin and eosin (H and E)-stained slide.

Acceptable: Slides

Collection Instructions: For each probe set ordered, 2 unstained consecutive tissue sections cut at 5 microns and placed on positively charged microscope slides. Include 1 H and E-stained slide.

Specimen Type: Solid tumor

Preferred: Tissue block

Collection Instructions: FFPE-tumor tissue block. Include 1 H and E-stained slide.

Acceptable: Slides  

Collection Instructions: For each probe set ordered, 2 unstained consecutive tissue sections cut at 5 microns and placed on positively charged microscope slides. Include 1 H and E-stained slide.

Note: No specimen should be rejected. If specimen not received at appropriate temperature, include note to laboratory. If questions, contact laboratory

Mature B-cell lymphoma can be low grade, intermediate grade, or high grade, and the prognosis and clinical course are highly variable. Genetic abnormalities have emerged as one of the most important prognostic markers in B-cell lymphomas and can aid in diagnosis. Several chromosome anomalies and variants of these anomalies have been associated with various lymphoma subtypes (see table below). Unfortunately, conventional chromosome studies cannot be employed on paraffin-embedded tissue, and molecular genetic analyses are often problematic in the study of lymphomas. Fluorescence in situ hybridization (FISH) permits the detection of abnormal gene associated with various chromosome translocations and inversions in B-cell lymphoma (see table below).  

An interpretive report will be provided.

A neoplastic clone is detected when the percent of cells with an abnormality exceeds the normal reference range for any given probe.

Detection of an abnormal clone is supportive of a diagnosis of a B-cell lymphoma. The specific anomaly detected may help subtype the neoplasm.

The absence of an abnormal clone does not rule out the presence of a neoplastic disorder.

This test is not FDA-approved and it is best used as an adjunct to existing clinical and pathologic information.

Fixatives other than formalin (eg, Prefer, Bouin) may not be successful for FISH assays.  

Although FISH testing will not be rejected due to nonformalin fixation, results may be compromised.

Paraffin-embedded tissues that have been decalcified are generally unsuccessful for FISH analysis. The pathologist reviewing the hematoxylin and eosin-stained slide may find it necessary to cancel testing.

Each probe was independently tested on a set of formalin-fixed, paraffin-embedded tissue specimens from patients diagnosed with a B-cell lymphoma and noncancerous lymph node specimen. Normal cutoff was calculated based on the results from 25 normal specimens. For each probe set a series of chromosomally abnormal specimens were evaluated to confirm each probe set detected the anomaly it was designed to detect.

WHO Classification of Tumour of Haematopoietic and Lymphoid Tissues. Edited by SH Swerdlow, E Campo, NL Harris. IARC, Lyon 2008, pp 214-217, 220-226, 229-237, 262-278

Rearrangements involving CCND1/IGH, IGH/BCL2, MYC/IGH, BIRC3/MALT1, and IGH/MALT1 are detected using commercially available dual-color, dual-fusion (D-FISH) strategy probes. Rearrangements involving MYC and BCL6 are detected using commercially available dual-color break-apart probe (BAP) strategies. Rearrangements involving MYC/IGL are detected using a laboratory developed D-FISH strategy probe and rearrangements of IGL using a laboratory-developed BAP strategy. Formalin-fixed, paraffin-embedded tissues are cut at 5 microns and mounted on positively charged glass slides. The selection of tissue and the target areas on the hematoxylin and eosin (H and E)-stained slide is performed by a pathologist. Using the H and E-stained slide as a reference, target areas are etched with a diamond-tipped etcher on the back of the unstained slide to be assayed. The probe set is hybridized to the appropriate target areas and 2 technologists each analyze 100 interphase nuclei each (200 total) with the results expressed as a percent abnormal nuclei.(Unpublished Mayo method)

B-Cell Lymphoma, FISH, Tissue

88271 x 2-DNA probe, each

88275-Interphase in situ hybridization, 100 to 300 cells

88291-Interpretation and report

One Additional FISH Probe

88271-DNA probe, each (if appropriate)

88275-Interphase in situ hybridization (if appropriate)

Two Additional FISH Probes

88271 x 2-DNA probe, each (if appropriate)

88275-Interphase in situ hybridization (if appropriate)

Three Additional FISH Probes

88271 x 3-DNA probe, each (if appropriate)

88275-Interphase in situ hybridization (if appropriate)

Four Additional FISH Probes

88271 x 4-DNA probe, each (if appropriate)

88275 x 2-Interphase in situ hybridization (if appropriate)

Five Additional FISH Probes

88271 x 5-DNA probe, each (if appropriate)

88275 x 2-Interphase in situ hybridization (if appropriate)

Six Additional FISH Probes

88271 x 6-DNA probe, each (if appropriate)

88275 x 3-Interphase in situ hybridization (if appropriate)

Seven Additional FISH Probes

88271 x 7-DNA probe, each (if appropriate)

88275 x 3-Interphase in situ hybridization (if appropriate)

Eight Additional FISH Probes

88271 x 8-DNA probe, each (if appropriate)

88275 x 4-Interphase in situ hybridization (if appropriate)

Nine Additional FISH Probes

88271 x 9-DNA probe, each (if appropriate)

88275 x 4-Interphase in situ hybridization (if appropriate)

Ten Additional FISH Probes

88271 x 10-DNA probe, each (if appropriate)

88275 x 5-Interphase in situ hybridization (if appropriate)

Eleven Additional FISH Probes

88271 x 11-DNA probe, each (if appropriate)

88275 x 5-Interphase in situ hybridization (if appropriate)

Twelve Additional FISH Probes

88271 x 12-DNA probe, each (if appropriate)

88275 x 6-Interphase in situ hybridization (if appropriate)

Thirteen Additional FISH Probes

88271 x 13-DNA probe, each (if appropriate)

88275 x 6-Interphase in situ hybridization (if appropriate)

Fourteen Additional FISH Probes

88271 x 14-DNA probe, each (if appropriate)

88275 x 7-Interphase in situ hybridization (if appropriate)

Fifteen Additional FISH Probes

88271 x 15-DNA probe, each (if appropriate)

88275 x 7-Interphase in situ hybridization (if appropriate)

Sixteen Additional FISH Probes

88271 x 16-DNA probe, each (if appropriate)

88275 x 8-Interphase in situ hybridization (if appropriate)

Seventeen Additional FISH Probes

88271 x 17-DNA probe, each (if appropriate)

88275 x 8-Interphase in situ hybridization (if appropriate)

Eighteen Additional FISH Probes

88271 x 18-DNA probe, each (if appropriate)

88275 x 9-Interphase in situ hybridization (if appropriate)

Nineteen Additional FISH Probes

88271 x 19-DNA probe, each (if appropriate)

88275 x 9-Interphase in situ hybridization (if appropriate)

Twenty Additional FISH Probes

88271 x 20-DNA probe, each (if appropriate)

88275 x 10-Interphase in situ hybridization (if appropriate)